Fever related illness non-urgent visit costs to a large pediatric emergency department.
The project will be a prospective, randomized controlled trial with a retrospective chart review of enrolled patients. Subjects will be selected from patients who have fever and are seen in the fast track area of our pediatric emergency department. our fast track area, while part of the emergency department, is a lower acuity area which serves patients who have non-urgent care needs. Subject recruitment times will vary and be pre-determined by physician work schedule. enrollment will be a convenience sample with the aim to enroll all potential subjects who meet criteria during the enrollment schedule. enrolled subjects will be randomized into three different study groups which differ in the type of fever education and follow-up intervention.
Group 1 is the control group and will undergo the normal standard of care currently given at Children's. This group will be given a fever education pamphlet, measuring syringe and thermometer for them to review at home. This group will be given the standard 3-month follow up call and a retrospective chart review will be done to measure CMC eD visit frequency.
Group 2 will be given verbal and written fever education (script included below) given by a member of the study team in addition to the pamphlet, measuring syringe and thermometer. This group will also be given the standard 3-month follow up call and a retrospective chart review will be done to measure CMC eD visit frequency.
Group 3 will receive verbal and written fever education given by a member of the study team in addition to the pamphlet, measuring syringe and thermometer and will also receive a 24 hour physician call back (script included below) after their visit to further educate, provide reassurance, and to answer any questions that may have come up after the visit. This group will also be given the standard 3-month follow up call and a retrospective chart review will be done to measure CMC eD visit frequency.
all parents/legal guardians will be called at three months to determine their experiences and usefulness of the kit materials. in addition, we will perform a retrospective chart review of all enrolled patients to determine the frequency of pediatric emergency department use 1 year prior to enrollment in the study for all patients enrolled who are 1 year or older. For patients, less than 1 year, we will perform a retrospective chart review from birth to the date of enrollment. after one year post-intervention, we will perform another retrospective chart review to determine the number of times the patient returned to the pediatric emergency department after being enrolled in the study. For each eD visit, a physician will review the charts and determine if the visits were a) urgent or non-urgent in nature and b) fever or non-fever related for each patient. We will specifically collect the following information from each chart: number of visits to the emergency department and the encounter dates, reason for visit to the emergency department (chief complaint), if the child left without being seen, vitals, payor status, if the child was admitted to the hospital, and basic demographic information (including race, ethnicity, birth date). We will then determine if our intervention decreased the number of times a patient would have returned to the emergency department. To analyze the potential cost savings of our intervention, we will complete a data query to determine the average cost of pediatric emergency department visits for fever and determine the difference or addition in cost after our intervention.
* Parent of patients between the ages of 3 months and 5 years presenting to CMCD fast track during the enrollment period.
* Parent of patients with fever or a fever-related complaint during the visit.
* Parent of patients with a designated triage level 4 or 5. (assigned by triage nurse)
* Parent of patients with a history of visiting CMC-ED at least 3 times in the last year.
* English or Spanish speaking families only
* Adult, 18 or older, who is a parent/legal guardian/primary caretaker of child eligible for the study.